When Melanie Law’s life depended on having her breasts removed, she wasn’t the least bit concerned about her appearance. But strangers and even health professionals made her feel like she should be.
“I was asked what my husband thought,” Ms Law said.
“My surgeon was worried about my mental health — if I wasn’t going to proceed with reconstruction, she was worried I’d be self-conscious.”
After reading thorough the information provided to her, she chose to undergo a double mastectomy and to remain flat-chested.
“At the time, I felt like my surgeon was questioning my decision and that I was making the wrong decision in her eyes,” she said.
While she’s certain it was the right decision, she said in hindsight she chose “unknowingly” because she wasn’t fully informed about the consequences of all options.
“At the time I was reactive because I just had enough,” she said.
Ms Law chose the option with the shortest surgery time and smallest chance of recurrence.
“I wanted to get out of the medical system because I had five months of every day either having phone calls, appointments, procedures, treatments,” she said.
Ms Law said she only found out important information after surgery — like having both breasts removed meant she didn’t have to take a strong course of medication used for breast cancer treatment for up to a decade.
‘Flat and fabulous’ community launches national study
Ms Smith has joined two other women from the “flat and fabulous” community to help launch a national study into breast surgery options, outcomes and resources offered ahead of a mastectomy.
Breast cancer survivor Joanna Atzori said while she was supported by her surgeon in her choice to remain flat, anecdotally the experience was rare within the breast cancer community.
“We’ve heard some horror stories about women being told that they might be aesthetically unpleasing if they don’t have breasts,” she said.
“Some of the comments that we’ve heard, include, ‘Maybe you should go and ask your husband or partner what they think’.”
She said women should be offered chest-inclusive options with equal weighting ahead of their mastectomies — both reconstruction and flat closure, which is when women choose not to have implants or breasts reconstructed from tissue from other parts of the body.
“Some people are being shared information at the time of their decision that maybe flat closure isn’t the best option,” she said.
“Some women aren’t given information [about flat closure] up front, maybe based on societal norms, or unconscious bias about what they think that the woman should want after their mastectomy.”
The study by Flinders University includes surveying women who removed one or both breasts as part of cancer treatment and chose to remain flat.
Researcher Dr Fiona Crawford-Williams, who is facilitating the study, said it would help fill data gaps, with no official numbers on women who decide to go flat following a mastectomy.
“This research study will give us a clearer picture by asking women about the reasons why they chose to go flat, rather than speculating based on societal perceptions and assumptions,” she said.
“The reasons often cited for low reconstruction rate in Australia is accessibility — that it is influenced by cost and availability, rather than women’s personal preferences to go flat.”
Staying flat a default option
Breast Surgeons of Australia and New Zealand president Dr Melanie Walker said women should always be offered all options and informed of the pros and cons.
“It’s all about being empowered to make decisions,” Dr Walker said.
She said in her experience, being flat was “always” discussed, and that breast reconstruction was not offered enough more broadly.
According to a study by the European Journal of Surgical Oncology, half of Australian women offered a mastectomy chose to remain flat.
She said because of the lack of access to mastectomy, the focus of research had traditionally been on reconstruction and that more data about flat closure was welcomed.
Informed data, informed decisions
Robyn Smith underwent a double mastectomy in 2019 to reduce her chance of breast cancer as she carries the BCRA gene mutation, which causes a higher risk of developing the disease.
She said she chose to get breasts implants after being told by her surgeon that flat closure had psychological impacts.
“I thought, ‘Oh, geez, I better do that because I don’t want bad mental health outcomes’ and that’s exactly what I had after I got implants,” Ms Smith said.
“After my implant surgery, I just I never really recovered and it just took me, you know.
“[I was] always fatigued, I had brain fog and memory loss and all this other stuff going on.”
She said having her implants removed resolved that, and while her surgeon agreed to leave her flat, she was offered alternatives in case she changed her mind.
“I often likened it to [going] into an ice cream shop: I confidently ordered a chocolate ice cream and the server kind of is like, ‘Ah, but just in case you don’t like that, why don’t you try a strawberry?’,” she said.
“While it was great to have the option and get that bit of information, I didn’t need it. I had my mind made up.”
She hoped the study would increase chest inclusivity, and more importantly, help women going through one of the most vulnerable times of their lives to feel supported.
“I’m a keen advocate for informed consent and what’s really important is for women to be told you’ve got three different options [with] the pros and cons of all of them,” she said.